Pathology in Hard Times

In Tanzania, we have a limited number of anatomical pathology laboratories – just four located in the zonal referral hospitals and a few privately owned labs in big cities such as Dar es Salaam and Arusha. This shortage of facilities exposes significant variation in pathology service delivery across the country – meaning that not only do many patients present to health facilities with advanced disease, but that even then, diagnosis and treatment are often delayed, leading to Tanzania’s high cancer mortality rate.

Only two zonal referral hospitals have access to telepathology; one is my institution, Kilimanjaro Christian Medical Centre (KCMC) in Tanzania’s northern zone. We have one slide scanner that enables us to send consultations to our pathology colleagues at Duke University and Nijmegen University; however, we face many challenges because of the high number of cancer patients – most of them from rural areas and presenting only in the late stages of disease. At KCMC, we have four “general” pathologists, which means we come across all kinds of cases – and heavily rely on telepathology to consult with experts in the US and the Netherlands on difficult cases. However, we have a lot of patients, and sometimes there is a delay in receiving replies to these consultations – which, in turn, means a delay to patient care. Nonetheless, our international colleagues perform these consultations in their spare time, without compensation for their time and dedication and we are grateful beyond words for their support in our work and in caring for our patients.

We also lack a standardized reporting system; only narrative reports are available, leading to many gaps in our pathology reports. The introduction of synoptic reporting would provide great value to our labs. There are ongoing talks about introducing synoptic reporting for breast cancer at KCMC– but this upgrade might take a year or two to complete. At the moment, we are looking for opportunities to find grants and collaborators to make synoptic reporting possible for all labs in Tanzania, and I want to champion this project.

Our main priority is to expand our services to reach a larger population while providing timely and definitive diagnoses – and this is where the power of digital pathology and artificial intelligence comes in. We need technologies that allow us to standardize our reporting systems, which will then improve data storage and retrieval for research purposes and to strengthen our cancer registries. So far, no labs have begun moving toward standardization, although visitors from abroad have come to observe and advise on KCMC’s cancer registry. The major factors holding us back are finding funding and identifying reliable collaborators from institutes that have already achieved better data management. 

The burden of cancer in Tanzania is devastatingly high, but I believe that strengthening our pathology services will help us work toward a better tomorrow. The future is bright. I look forward to learning from others to grow our community – and, hopefully, to welcoming more members of the global pathology community to our country.